Recurrence isn’t pretty part 6 – it’s a zebra!

There’s an idiom that goes – “when you hear hoofbeats think horses not zebras”. Apparently it’s taught to doctors learning their trade, so that they assess symptoms and think the most common cause first ie horses without jumping to the rarer or more serious cause ie zebras. Spoiler alert! Zebras are the theme of this post.

I had the follow up cystoscopy in September and after only a month my bladder was shockingly more inflamed and even redder. I was still getting martini-red pee too. I knew my bladder needed further investigation in hospital even before my urologist broke the news. My daughter was with me again to hug and console. It’s so important not to go alone to these things if you can organize it. Having a hand to hold can make a lot of difference. My husband was out of hospital after his stem cell transplant but his suppressed immune system kept him home.

A bladder biopsy was booked for October. I focused on looking after the patient at home, work and reassuring myself that the CT scan in August had been clear.

Hearing those hoofbeats and thinking horses.

I was very concerned to be away from home in the circumstances but my hospital team were sympathetic and speeded me through the pre-op and the hospital stay.

During the TURBT (my 12^th) they used hexvix – a photoactive fluorescent substance that lights up minute tumours in pink under blue light. This photodynamic diagnostic tool is introduced into the bladder up to 2 hours pre-operation. It even shows up the hard to detect carcinoma in situ (cis) in the bladder lining (see pictures). They took 6 samples. The pathology shows that from the 6 samples 4 contained cancer, three as before small low grade PTa G1 with good margins but the fourth is high grade a very tiny cis that also had good margins.

Thankfully all non-muscle invasive and all small.

But nonetheless those hoofbeats were zebras!